Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions

Background Clustering of lifestyle risk behaviours is very important in predicting premature mortality. Understanding the extent to which risk behaviours are clustered in deprived communities is vital to most effectively target public health interventions. Methods We examined co-occurrence and associations between risk behaviours (smoking, alcohol consumption, poor diet, low physical activity and high sedentary time) reported by adults living in deprived London neighbourhoods. Associations between sociodemographic characteristics and clustered risk behaviours were examined. Latent class analysis was used to identify underlying clustering of behaviours. Results Over 90% of respondents reported at least one risk behaviour. Reporting specific risk behaviours predicted reporting of further risk behaviours. Latent class analyses revealed four underlying classes. Membership of a maximal risk behaviour class was more likely for young, white males who were unable to work. Conclusions Compared with recent national level analysis, there was a weaker relationship between education and clustering of behaviours and a very high prevalence of clustering of risk behaviours in those unable to work. Young, white men who report difficulty managing on income were at high risk of reporting multiple risk behaviours. These groups may be an important target for interventions to reduce premature mortality caused by multiple risk behaviours.

Turning around the poorest neighbourhoods: learning the lessons from twenty years of neighbourhood-based regeneration strategies in England

In the past two decades governments in Britain have launched a series of initiatives designed to reduce the disparities between areas of affluence and deprivation. These initiatives were funded by central government and were delivered through a series of partnership boards operating at the neighbourhood level in areas with high levels of deprivation. Drawing on similar approaches in the US War on Poverty, the engagement of residents in the planning and delivery of projects was a major priority. This chapter draws on the national evaluations of three of these programmes in England: the Single Regeneration Budget, the New Deal for Communities and the Neighbourhood Management Pathfinders. The chapter begins by identifying the common characteristics of these programmes, known as area-based initiatives because they targeted areas of concentrated deprivation with a population of about 10,000 people each. It then goes on to discuss the three national programmes and summarises the main findings in relation to how far key indicators changed for the better. The final section sets out the ways in which policy objectives changed in 2010 after the election of a coalition government. This produced a shift to what was called the ‘Big Society’ where the rhetoric favoured a transfer of power away from central government towards the local, neighbourhood, level. This approach favoured self-help and a call to volunteering rather than channelling resources to the areas in greatest need. The chapter closes by reviewing the relatively modest achievements of this centralist, big-state approach to distressed neighbourhoods of 1990–2010.

Cultural value of architecture in homes and neighbourhoods

This paper provides an account of the Cultural Value of Architecture in Homes and Neighbourhoods, (CVoA), a project developed with the Royal Institute of British Architects (RIBA). The first stage of the project was a critical review of ‘grey literature’ since 2000, industry based research on the value of architecture subdivided into themes: overall value; health and wellbeing; neighbourhood cohesion and heritage and belonging. Findings from the review revealed a marked absence of evidence of the value of architecture and an over preoccupation with the final building, the product of an interdisciplinary team not just Architects, as well as a general confusion about what it is that Architects do. Further consultation has led to the development of a framework for defining and communicating the skillsets of Architects and for developing an evidence base for their value. Our target audience is non-Architects as we are concerned with making the profession more inclusive hence our desire to create simple definitions and terminology.

Old buildings, new landscape : Redeveloping historic neighbourhoods - A case study of Xin Tian Di, Shanghai, China

This paper explores the use of tradition by the redevelopment project ofXin Tian Di (New Heaven and Earth) in Shanghai. The paper also identifies the implications of this urban redevelopment project to historic quarters in Chinese cities. An enormous commercial success and new Shanghai icon, Xin Tian Di project has transformed a former residential neighbourhood into a high end entertainment precinct. While the redevelopment ofXin Tian Di has retained the architectural features of the place, the use and interpretation of tradition by the project is problematic. The project shows a tendency where the established idea of tradition is destabilised and challenged. It also highlights issues of cultural authenticity in the redevelopment of historic quarters.

Residents' perceptions of walkability attributes in objectively different neighbourhoods: a pilot study

Physical attributes of local environments may influence walking. We used a modified version of the Neighbourhood Environment Walkability Scale to compare residents’ perceptions of the attributes of two neighbourhoods that differed on measures derived from Geographic Information System databases. Residents of the high-walkable neighbourhood rated relevant attributes of residential density, land-use mix (access and diversity) and street connectivity, consistently higher than did residents of the low-walkable neighbourhood. Traffic safety and safety from crime attributes did not differ. Perceived neighbourhood environment characteristics had moderate to high test–retest reliabilities. Neighbourhood environment attribute ratings may be used in population surveys and other studies.

People, places and policies – trying to account for health inequalities in impoverished neighbourhoods

Objective : We consider associations between individual, household and area-level characteristics and self-reported health.
Method : Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage.
Analysis :This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits.
Results : There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best.
Conclusions : Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level.
Implications : The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.